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Thermoregulation
| Question | Answer |
|---|---|
| the result of inadequate heat loss | hyperthermia |
| Sx: profound CNS dysfunction (confusion, delirium, bizarre behavior, coma, seizures); elevated body temperature (40.6°C [105°F] or higher); hot, dry skin; and usually anhidrosis (absence of sweating), tachypnea, hypotension, and tachycardia | hyperthermia |
| Tx: use ABCs and reduce temp to 39°C asap; cooling methods (cool sheets/towels/sponging w/cool water; ice to body crevices; cooling blankets; iced lavage of stomach or colon; cold water bath); monitor temp, VS, ECG, CVP, LOC, urine output; IVF | hyperthermia |
| monitor what with hyperthermia? | temp, VS, ECG, CVP, LOC |
| malignant hyperthermia affects what ages? | 30 y.o. or below |
| a severe reaction to a dose of anesthetics; the reaction is sometimes fatal; it is caused by a rare, inherited muscle abnormality; infrequently, extreme exercise or heat stroke can trigger this in someone with the muscle abnormality | malignant hyperthermia |
| common surgical paralytic that can cause malignant hyperthermia | succinylcholine |
| Sx of malignant hyperthermia occur within what time frame? | within first hour of exposure up to 12 hours after |
| Sx: -dramatic rise in temp (sometimes as high as 113) -rigid or painful muscles (esp in jaw) -flushed skin -sweating -tachycardia, tachypnea, hypercapnia -brown or cola-colored urine -hypotension (shock) | malignant hyperthermia |
| acid base disorder with malignant hyperthermia? | metabolic acidosis (d/t decreased HCO3) |
| electrolyte imbalances with malignant hyperthermia? | -hyperkalemia -increased lactate -decreased HCO3 |
| med used to treat and prevent malignant hyperthermia | dantrolene |
| Tx: -Resolves w/Tx within 12-24 hours -dantrolene -lower body temp -administer Oxygen -control HR and B/P -monitor in ICU -give bicarb -decrease K | malignant hyperthermia |
| three meds given to decrease K | -insulin -dextrose -Ca gluconate |
| causes: spinal cord injury, infection, alcohol ingestion, homelessness, trauma victims | hypothermia |
| treatment for hypothermia? | controlled rewarming (including active internal (core) rewarming and passive (spontaneous) or active external rewarming) |
| ______ is ineffective in patients with temperatures lower than 31°C (88°F); therefore, the patient must be rewarmed first. | Defibrillation |
| resumption of sustained perfusing cardiac activity associated with significant respiratory effort after cardiac arrest; Sx of this include breathing, coughing, or movement and a palpable pulse or a measurable blood pressure | Return of spontaneous circulation (ROSC) |
| Following resuscitation and ROSC, pts who are comatose may benefit from this; includes inducing a drop in core body temp to 32°-34°C (89.6°-93.2°F) for 12 to 24 hours postresuscitation in order to decrease the cerebral metabolic rate and need for oxygen | therapeutic hypothermia protocols |
| causes: heat stroke, long hours in heat, dehydration, left in closed hot space, fever, infection, tumor in brain, extreme heat | hyperthermia |
| During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following? -Rebound hyperthermia -Metabolic acidosis -Anaphylaxis -Hypoxia | Metabolic acidosis (When a patient's temperature falls, glucose metabolism is reduced. As a result, metabolic acidosis may develop. Rebound hyperthermia, anaphylaxis, and hypoxia are not associated with hypothermia during surgery.) |
| After teaching class about agents commonly associated w/onset of malignant hyperthermia, instructor determines that add'l teaching is needed when students identify which drug as a possible cause? -Halothane -Succinylcholine -Epinephrine -Morphine | Morphine (Morphine is not associated with malignant hyperthermia. Agents such as halothan, succinylcholine, and epinephrine can induce malignant hyperthermia.) |
| OR nurse is required to assess pt continuously and protect the pt from potential complications. Which Sx would the nurse watch for as indicative of malignant hyperthermia? (select all) -Cyanosis -Cardiac arrest -Increased urine output -Mottled skin | Cyanosis, cardiac arrest, mottled skin (Symptoms of malignant hyperthermia include tachycardia, tachypnea, cyanosis, fever, muscle rigidity, diaphoresis, mottled skin, hypotension, irregular heart rate, decreased urine output, and cardiac arrest.) |
| Pt undergoes induction for general anesthesia at 8:30am and is being assessed cont. for onset of malignant hyperthermia. Which time would pt most likely show Sx of this condition? -8:40 to 8:50 am -9:00 to 9:10 am -9:30 to 9:40 am -10:00 to 10:10 am | 8:40 to 8:50 am (Malignant hyperthermia usually manifests about 10 to 20 minutes after the induction of anesthesia, which in this case would 8:40 to 8:50 am) |
| A nurse suspects malignant hyperthermia in a patient who underwent surgery approximately 18 hours ago. Which of the following would the nurse identify as a late, ominous sign? -Rapid rise in body temp -Oliguria -Tachycardia -Muscle rigidity | Rapid rise in body temp (A rise in body temp is a late sign that develops rapidly, with the temp possibly increasing 1 degree to 2 degrees C every 5 minutes and body core temp exceeding 42 degrees C (107 degrees F).) |
| During surgical procedure, pt exhibits tachycardia, generalized muscle rigidity, and a temp of 103°F. The nurse should prepare to administer: -verapamil (Isoptin) -dantrolene sodium (Dantrium) -potassium chloride -an acetaminophen suppository | dantrolene sodium (Dantrium) (The client is exhibiting clinical manifestations of malignant hyperthermia. Dantrolene sodium, a skeletal muscle relaxant, is administered.) |
| Pt develops malignant hyperthermia. What client Sx would the nurse most likely observe as the first indicator of the disorder? -body temp increase of 1-2 °C (2-4 °F) -tentanus-like jaw movements -gen. muscle rigidity -HR over 150 bpm | HR over 150 bpm |
| Homeless pt presents to ED; experiencing hypothermia. Nurse will plan to complete which priority intervention during rewarming process? -Attach a cardiac monitor -Insert Foley urinary cath -Assist w/endotracheal intubation -Administer inotropic drugs | Attach a cardiac monitor (Continuous electrocardiograph (ECG) monitoring is performed during the rewarming process because cold-induced myocardial irritability leads to conduction disturbances, especially ventricular fibrillation. ) |
Created by:
nurse savage
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